Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | SC |
NPI | 1093189771 |
---|---|
Provider Name | Cheryl Wisener |
First Address | Clover, SC 29710-8793 |
Second Address | Clover, SC 29710-8793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2015 |
Last Update Date | 18/11/2015 |